Given the population density in India and the explosive rate of person-to-person transmission the coronavirus can achieve, the situation can be potentially catastrophic
Recently, the WHO declared a Public Health Emergency of International Concern (PHEIC) pertaining to the coronavirus cases being reported from China. The virus, with its epicentre located in the live animal market of Wuhan city, infected more than 10,000 people in China till January 31. This is more than the number of people infected in the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic.
Till now, more than 200 people have succumbed to the virus, which is a novel variant of the coronavirus family (2019 n-Cov infection), which is the same family as the SARS virus. It also has similar symptoms like fever, cough and difficulty in breathing, which are also typical to the battery of symptoms a patient displays during pneumonia.
The typical clinical profile of patients has been a spectrum: From common cough and cold to severe cases of pneumonia and death. The severity of the 2019 n-Cov has not been completely established but it can be safely assumed that the severity will be higher in people with lower immunity. So in patients with HIV, those on immune-suppressants and even people suffering from malnutrition, especially older people, the severity of infection can be assumed to be higher.
While Beijing has quarantined Wuhan and a few other cities, countries are taking their own measures to ensure containment of the virus. While nations like Russia have closed their land borders with China, others are focussing on airports and sea ports. Thailand, Singapore, Hong Kong and Japan have set up thermal cameras at all airports to ensure screening of passengers with fever. But since the infection can be asymptomatic for seven to 14 days, the system in not foolproof.
The USA, on January 31, took a rather bold stand, releasing the Presidential “Proclamation on Suspension of Entry as Immigrants and Non-immigrants who pose a risk of transmitting 2019 Novel Coronavirus”, which suspends the entry into the US, as immigrants or non-immigrants, of all aliens who were physically present within the People’s Republic of China, (excluding the Special Administrative Regions of Hong Kong and Macau) during the 14-day period preceding their entry or attempted entry into America.
The US has 241 suspected cases of which six have been confirmed as a lot of Chinese families had planned their travel to the USA at this time to celebrate the new year with their families.
The first case in India was reported in Kerala. Since then, the Government has been on high alert and the Government machinery has been prepared to prevent further exposure of the pathogen inside borders as well as contain the current situation.
The National Institute of Virology, Pune tested 49 suspect cases, of which only one turned out to be positive. But the fear of the virus hitting Indian shores and exploding into epidemic proportions is real. If we compare it with the SARS 2003 numbers (a very gross analogy nonetheless), China had 5,327 cases and 348 deaths confirmed and India had about three probable cases, 10 suspect cases and no fatalities. The global number of infected cases for SARS were 8,098.
Currently, the number of cases for 2019 n-Cov just in China has exceeded 10,000 and India has one positive case. Some of the things we do understand is that due to poor nutrition and thus poor immunity, the risk of getting infected on exposure to the virus is high.
The severity of disease on infection is also expected to be high in such populations. Now in that scenario, imagine the population density in India and the explosive rate of person-to-person transmission the virus can achieve. The situation can be potentially catastrophic, especially considering the fact that the health infrastructure required to manage a large disease burden such as this, is not nearly adequate.
India ranks 57 of 195 countries in the Global Health Security Index. The index, developed jointly by Johns Hopkins Center for Health Security, the Nuclear Threat Initiative, and The Economist Intelligence Unit, ranks countries based on preparedness to handle public health emergencies.
Countries are assessed across six categories: Prevention of the emergence or release of pathogens; early detection and reporting for epidemics of potential international concern; rapid response to and mitigation of the spread of an epidemic; robust health system to treat the sick and protect health workers; commitment to improving national capacity, financing plans to address gaps and adhering to global norms; and overall risk environment and country vulnerability to biological threats.
While there are multiple indicators within the same, we must focus on some relevant to the current threat scenario. India ranks 142 of 195 in public health vulnerability: This includes access and expenditure on public health.
This implies that our health infrastructure cannot absorb large shocks. India ranks 144 of 195 in cross-border policies for public health emergency response. We have no recorded measures for international cooperation or even regional cooperation for health emergencies.
India ranks 167 in access to communications infrastructure: Which measures access to internet and the possibility of communicating to the masses, messages regarding public emergencies.
This is contestable given the large mobile penetration even in remote areas but at the same time the fact remains that we do not have a robust system to disseminate public emergency messages to the masses in a planned and actionable manner. We are ranked 101 in terms of immunisation, leaving a vast majority vulnerable to infections. Considering these points, it is evident that if the disease is not contained, results can be catastrophic for us.
The Indian Government has been taking good measures to screen for and contain the virus. Airport Health Organisations at Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad and Cochin are screening passengers coming from China. But most of the screening, for now, is based on self-reporting and symptomatic interviews by airport authorities.
The Mumbai airport has reported universal thermal screening by cameras for all flights coming directly from China. Screening is even being carried out at sea ports for all personnel disembarking from ships coming from China. There are quarantine centres with 300-bed capacity set up in Manesar, Haryana and 600-bed capacity in south-west Delhi, ready for any confirmed cases.
About 400 Indians are currently being evacuated from the Wuhan area. Since the one case confirmed in India, a student from Wuhan University, 1,073 people have been kept under observation in Kerala while the student is being managed in Thrissur Medical College. The Ministry of AYUSH has also released an advisory for the management of coronavirus on the Press Information Bureau.
The Ministry of Health and Family Welfare has set up a helpline with a 24X7 call centre for coronavirus (helpline number 011-23978046).
They are encouraging all people who have travelled back from China after January 1 to self-report symptoms and follow up on care. Complete ban on travel is not practical and in the absence of that from all countries, people who have a travel itinerary which (in part) included China, are now travelling from a different country, can be carriers.
The challenge also is that the disease is airborne can be asymptomatic for one to two weeks, making it extremely difficult to detect early. At the same time heavy screening and observation of all passengers can be cost-intensive.
In the light of the same, measures need to be taken to establish screening centres at a minimum four ports of entry, with the relevant manpower and technology for screening and quarantine. Then mandating all flights from China to be routed through these airports only.
Passengers must be informed in advance that this will increase their travel time and based on screening results they might be referred to a local health set up for quarantine, leading to additional delays. The passengers might also have to declare two weeks’ voluntary isolation based on screening results. With these checks in place, only extremely important travel can be filtered and borders can be managed skillfully.
To maintain foreign sentiments, an earnest declaration should also be made by the state leadership that this is not because we have low confidence to the Chinese measures already being taken but additional measures are being taken in the interest of national security.
(The writer is an Engagement Manager, Health, International Innovation Corps, University of Chicago Centre, Delhi)
